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HomeMy WebLinkAbout0042 POWERS DRIVE - Health 42 Powers Drive Centerville A = 167 038 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville V/ MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. A. Inspector Information �� � 1. Inspector: Michael DeCosta,Jr. Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (508)400-8083 SI 13230 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 2 Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails _71& - d. August 6, 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 20 f Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 CityfTown State Zip Code Date of Inspection C. Inspection summary Inspection Summary: Complete 1,2, 3, or 5 and all of 4 and 6. 1)System Passes: 0 I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The center cover is on a riser to grade. 2)System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below) t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 2 of 20 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 Cityfrown State Zip Code Date of Inspection C. Inspection summary (cont.) 2)System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced 0 Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3)Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a.System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System♦Page 3 of 20 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments c, 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b.System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: " This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 20 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems:(cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed- pipe(s). Number of times pumped:_ ❑ Q Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5)Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 CityTrown State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No Q ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Q Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components, excluding the SAS,located on site? [Jf ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? Q ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems?The size and location of the Soil Absorption System(SAS)on the site has been determined based on: [Jf ❑ Existing information. For example, a plan at the Board of Health. ❑ Q Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 6 of 20 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? Q Yes ❑ No Does residence have a water treatment unit? ❑ Yes Q No If yes,discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes Q No information in this report.) Laundry system inspected? ❑ Yes Q No Seasonal use? ❑ Yes Q No Water meter readings, if available(last 2 years usage(gpd)): 47 GPD Detail: Usage: 34,100 gallons/730 days=46.7 4 47 GPD. See attached Customer Statement provided by C-O-MM Water Department. Sump pump? ❑ Yes 21 No Last date of occupancy: Current Date t5ins.doc 0 rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 7 of 20 LN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes,discharges to Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): General Information 3. Pumping Records: Source of information: Wind River Environmental—See attached. Was system pumped as part of the inspection? 10 Yes ❑ No If yes,volume pumped: 1500 gallons How was quantity pumped determined? Quantity measured by pump truck Reason for pumping: Check structural integrity of the tank t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 8 of 20 I Commonwealth of Massachusetts W Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Q Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 2004 per plans Were sewage odors detected when arriving at the site? ❑ Yes Q No 5. Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron Q 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting,evidence of leakage,etc.): Unable to enter home and check piping due to COVID-19. t5ins.doc rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 20 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3.6 feet Material of construction: Z concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 5' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The inlet and outlet covers are 3.6'below grade.The center cover is on a riser to grade.The tees are in good condition.There is no filter installed on the outlet.The liquid level is normal with moderate solids and sludge.The tank appears to be structurally sound and not leaking. Recommend installing a 3'riser on the inlet and outlet covers so that the tees are accessible and can be checked regularly. Pumping should be done annually. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 20 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level:_ Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The distribution box is 4'below grade and 16"x 12".The box has two outlets accepting equal flow.The liquid level is normal with minimal carryover into the box.The box is in good structural condition, is watertight and is not leaking. Recommend installing a 4'riser on the distribution box for future access. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 12 of 20 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6,2020 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number: [� leaching chambers number: 5 @ 500 gallon ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 13 of 20 I Commonwealth of Massachusetts Title 5 Official Inspection Form 'a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(Cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): A riser has been installed to within 6"of grade to make the chambers accessible.The chambers have over 2'of available space.There is no evidence of high staining or hydraulic failure and the vegetation is normal. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 14 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately TMW OF UARNSTAIJU LOCATION y/2 Addl-6 SEWAGE N VILLAGE CO.,r ASSESSOR'S MAP&Ir1T /6 INSTALLER'S,IAME&PHONE NO 1 Ih�C1C+y SEPTIC TANK CAPACrrY 1 ti Soo _ LEACHNG FACI1M.(type) 0o drpv3U,, (azu) i2tl %_jam —• NO.OF ablAboms 817Q.DER 0 e.� PERMMDATE:. !t0 V —COMPLIANCE, VATL•: hk Stpwi ioe Distaaee Detwesn the: hairirouin A4juitclCr;witdwat=r•!uNc(uHteBOlamcfLt'3%ire Fwaity Ott Private Water Supply Well and Leaching Faritity (If any Y'V116 eutl Jy lG 00 Cite"Wilton Zoo reet or teaching rximy) V Feel Edge of Walzand end WiNng Facility(If any wdlwsds exist within 300 feet of keaehirtg�c V ti FicY, Furnished by ''ll�a y yi n dY a �s 6 y- t5ins.doc rev.7/26/2018 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 20 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Q Check Slope Q Surface water Q Check cellar Q Shallow wells Estimated depth to high ground water: 10'+ feet Please indicate all methods used to determine the high ground water elevation: ❑J Obtained from system design plans on record If checked,date of design plan reviewed: 2004 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Obtained groundwater information from the design plans on record. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 20 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is Owners Name required for every page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information: Complete all fields in this section. Q B. Certification: Signed&Dated and 1,2,3, or 4 checked Q C. Inspection Summary: 1,2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed Q D. System Information: For 8:Tight/Holding Tank-Pumping contract attached For 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 20 C Commonwealth of Massachusetts w f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is Owners Name required for every page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection Customer Water Statement C-O-MM WATER DEPT CUSTOMER STATENEW MACIOLEK,JOHN R A ELMASM LOCATM +42 POWERS DR CEN � 1 (►SAP&Pi JQ1, 167039 Consrnnptioa I#wVY am B� 44 1251119 1990 102 "119 1978 51 12t AS tar 144 Consumption is measured by the thousand gallons. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 19 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form x - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Powers Drive Property Address Owner John Maciolek information is required for every Owner's Name page. Centerville MA 02632 August 6, 2020 City/Town State Zip Code Date of Inspection Pumping Record Worft<kder;?0217079147 Caat914GG734 CecmmwSinoc2011 TW.6.2600 yl�atixxa ft fit.13/::ar Kai 2:oche reoasd for d' oy I/«l «arfr a,ob Cwarmz TetflCorrar Tcr�aCRiexe (sb c/arsey data) C%C It01 Cst 1" $69 t,ak park 20«:aalSal2. N.acarwnsad Ka r*C0r'nrrlst;rn.. Saerr !gt»d ecrrnnt f.109, seed water ante.M rater plats►re,•. LFiarattt5 Moe. 33o2wl rater level, ttY.arate tap .fits Lutz=CIDYIC -@II solids., Moderate bat.too.slam*. Salo- half:*.are loi.act. socked wits k:arabetlir ra:l a'L.Wid eM Sat.272.1122 "fr. line vicar.lla:titaz is r esaot M t.'..e Sakti, Current 2 Ur ttta.la=. It exceeded 4110 For Mrzr rill x-vlr* tans can be attfitteS with a tttter.. rorotrarded Dxak. addltiva, C_iG adSitive. Cararwrl secured. ^.1o3s+wtai: CStrtwur raaolpt to t .ta frWil ::awnlra:.t®1 Yay.cval+a Cr .erviced 'LO�2 Sallrare 4rce septic tack. ba filter. 20CCO tn3ed Et0-boast err.oct.a4 V.37log ataxy two year.. 'cdtds ware :Lt`J!. and sin wan exate. Crier secured. fa1t1$Y eater taro..4ig.e. cc WlO p ralsd■. L got bctkow stw•go. .ns.t tart as Ara intact. . 711ter ala.,? .t�Cti6'CrMed C=addsttw, catall"a filter. z v,—i mcCrgd. Srt wn $ya m L,00ation i;•1tt.,`ss.'.Maeiata'L Prtraey�Die -42 Pcvard?rive 42 Pawxe Drive ante:wtl'le, KL CZC32 Oanlerrtlts,. MA 01922 1:0A1 420.4191 ltactoisk ltlixieth . (S¢lt 42C'-Sl47 SOL1r G0 Otte: ST 6!/Fsf7124 01.00 CM PfOglfini'ys Cdl t0 Yairdirm! Rwt—A Type: Stantas3 PYCview semko., 0,'1/21/2s2O Depth Maw Gfado:d Custom etesn: tauttlp Ddta1^. Cwt trades: 10 FCter- TUAIMp Impettio rm— Utilityl tlims".aDle Burdup: dots Ilret X 140 cc fie 2"M .oa t e- *MT 'c tsj FM,/3 ♦ r/,.w W W Y.:mj»ctfen ll.abarPCtpnevrore.r:par;hr. i:.oa s ts= 9.oD 9 :sr..oa - inspection Iitto S 7"a Ps isle %NI - IWO 1.00 2 14;.L.DO 4 aCO.OD C°.vl rcineoisl CcnPll.z" -.T..Ld,- 1.t 1.0D g 7.a100 a .Y.OD 6`sp2 d 1lrargy lcazzaery . . leOL, g ti.1250 2 Gt.It Additlazal roc tartar par:vur 2,00 a Iv .0.00 10D.00 uaad:0. 12GL.1;1 %ISLA et:?+n41 kor t.Sato kov Your f somhkarr. to s 2 O.OD. •R.eeMI. tisoW •1.0+KtStissY,J eScMw Iw :0 12i&.SY .thimalt'lrr sy.oralfi:e: Ofsprrap V&rre: Fayrewocnv wx:o Ced1 t o.edal ttect 7 'IC.C4P: x2l Tapatza Install. CSR: ltyan Crc:cl' Duo,=lacatFt Tnt#: TCU610dtla':xicrtxol2aca,.:ajr- onst'.e:O:.1LtK PoMul-bc#1 Tom llrtN.. Irtrn*mraticl 71na. nerral altar 1ere1.. Lt gsl. kLceFp solids, LtgLit l+Uce s.•tileo-. `ScL--bullter are iaLstt. K&'-ft.llte ltct AFp''I=ble . Da FS,:ter Is Fremont on the tank, currcat tarn can:e cutltttol with a etlker. C:sror(s) Customer not an site secured. Title,b :ft"Mlat to A tares, Cull resort will to w^aat Yed to cur:ooar nvcs p a'leam ecr Snsnarllae t. rscetvad, na erudst ,;.art no.f.t:e on,C.-M.lc.on x' Mto, cu.tamr a.:ted ta.tilt .hta, cft*zU3 with office,et:'d, tech to ru p later - - - tm2ay tL:O gala, rnlwae-catact efftce ta.call In credit card ec to,p,,;l. !n CutWnlirSpj-U- crack. A:1 rat Viet yam..aeaaceaanSsd tkr$e=erarnSit/cn. WINDRTVER t5ins.doc a rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 20 of 20 1 I I I fin/L-�I 1 '� / � � I / I i • n) h z / ' / I Pvc OD r , 1 /I r F `J All I W I .oa I � I ►.� I I / / �/ l TOWN OF BARNSTABLE L OC'ATION Y2— Pdaeri SEWAGE # o�&L. ?60 2 VILLAGE ASSESSOR'S MAP & LOT--&-2 lye INSTALLER'S NAME&PHONE NO. �AkCk� SEPTIC TANK CAPACITY !no fI LEACHING FACILITY: (type) du (size) NO.OF BEDROOMS BUILDER O "NE PER IT DATE: /1 JIV COMPLIANCE DATE: / l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) (J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching ciliq) Feet Furnished by ���� I /�i�' �� J� ���3�� � ��, yG � ,. �� d �s �y� �� No. � Fee js, 0 s THE COMMONWEALTH OF MASSACHISSET°T19 Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Miopooal bpztem Conztrurtion Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L42. Pow a tt s DR I✓hs Owner's Name,Address and Tel.No. C 6A raixVI LL6, MAs s ScchN +GL1z.A®ArT'H M.4G104.CA Assessor's Map/Parcel S 13AN FrIl-L I-N- M 1 b-7 P So4T145oRG4GM ASS Installer's Name,Address,and TeWlwq Designer's Name,Address and Tel.No.50&— L'1 Z.g�—33�1�1IAVI`,IN1i)LR Sui..LivAA, ArIV&UvisffRIX* -7 PAKL'R tZO. OSTG/2 Vl LL.F: ASS Type of Building: Dwelling No.of Bedrooms Lot Size 1.6S Ac mp€t. Garbage Grinder(NOD Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5S0 gallons per day. Calculated daily flow 6_6& gallons. Plan Date 06C. 41 2.0 0 3 Number of sheets ( Revision Date Title SI-rrs OLAN - PRoPosED SITE• IMPROy6/N6A/t's Size of Septic Tank /500 a.9Z_ --OIVf Type of S.A.S.1 z'x 4s�L +I9�iA- �1/�WBEIZL. I0Y12 4/s. .. Description of Soil O-114 Ole &Msh 1312iyMBD somp A 0 14 -33 DR1C Y&L'ish BQV Mho' SAME> -D- 10YR- 4L6, 33"-120't Lt. YEL'ISh 13RN -t1wD. SANG -'C- 2-5*Y 6/y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be n iss Board 9LHeglth. Si d Date /0_'0r/0 Application Approved b Date /flzobse Application Disapproved for the following reasons Permit No. 000 3—401Z Date Issued / l Q J0 3 U ci No. �, 1"�," 'tw ,: Fee O THE COMMONWEALTH OF IIhAS��S'_VPTS` Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for ;Di!6po5ar A pgtem Cott!gtruction 3permit. Application for a Permit to Construct%)Repair'( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. H Z PO w L M S D R 11/[y Owner's Name,Address and Tel.No. CL:A,-reLV1LLC , /"/-�15 r .TGhN b L=1_17 3ETH MACIoL[-K Assessor's Map/Parcel S 13 A N F I L L L N- M t L.-7 P 38 ,• 5a4TN►3URGUGFI Installer's Name,Address,and Tel.No ' 1�p Designer's Name,Address and Tel.No.5-05 - r-1 —3 3'1 L'/j1 /N�{11t)�flJ Su �LiV/aN L'NU NC. R rBiNfLN�. -7 PARKER �Z►C'- OSTL=2 ✓1 L•LL" ),455' Type of Building: M Dwelling No.of Bedrooms 5 Lot Size 1.65 Ac sift. Garbage Grinder(N P Other Type of Building -No.of Persons Showers( ) Cafeteria( ) Other Fixtures -if, s �, r s +Design Flow So gallons pet day. Calculated daily flow .SGF? gallons. Plan Date D a e . 9 ZD 63 Number of sheets 1 Revision Date Title SIT& PLAN - PROPaSED SIT,& IMPIZOVC- 1L'/VTS Size of Septic Tank /5D0GAL-L_pNs Type of S.A.S.I a'xys' L 6,46Livy 6va��+l3ElL IUY2 y/2 „ Description of Soil 0- I DIe GrN/i5h BR A)cD 5�0ivD-A , 1 `4 -33" D2IC YEL'rsh V rv1ED SAN1� -13 — 10Yf2_ 1{16, 33"- 12.0 Lt. VEL'156# 132W �9- I'IE1) , S�>Iy(� —C.- � — Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: " The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system '~ in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has her iss h' Board of Health. Si , Date � /�/03 Application Approved b Date b 0!/ r Application Disapprove for the following reasons Permit No. ;�00 3—4C'_ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER IFY,that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( ) Abandoned( )by c. Lein at H 2 Power 2 S I�'21 y[ 1 C L/v'TC12 1// LL.t ik7/-9 5 r has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r? 0-7 dated a Installer Designer 1.1 l L ✓A 4AJV& E12(/v W . The issuance o this a it shall not be construed-as a guarantee that the Sy tem- ill'- notion as des ed. Date l Inspector vi" �? ----------------------------------------- No. A, ��k7O Fee L THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpo5ar *p5tem Con!6truction Permit Permission is hereby granted to Construct(x)Repair( )Upgrade( )Abandon( )-,` System located at`")Z Pb W E R S D R I✓C C E-W R!�/L L B and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or-special conditions. Provided:Constru ion rqUst b completed within three years of the date of tPOA, Date:_ Approved by 1 L's TOWN OF BARNSTABLE LOCATION Pdaei .S P SEWAGE # _ �60 ? VILLAGE ed r ASSESSOR'S MAP &LOT 9 2 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��5DO • LEACHING FACILITY: (type) C5-) 'J> (size) YS® NO.OF BEDROOMS BUILDER !OEWN:E e PERMIT DATE: Yt dt COMPLIANCE DATE: /.� nq Separation Distance Between the: '. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching cil ) Feet Furnished by yy� H �Y� Town of Rarnstablc rr� iO,s9ti , Department of health,Safely,and Environmental Services Public Health Division Date /01/(O/o3 367 Main Street,I lyannis MA 02601 % 9ABNSTAer$ KAM Alforud" Dale Scheduled 1_p��f�lp� Thile IO:OU Fee 11tl. 100— Soil Suitability Assessment for Sewage Disposal Performed By: SvI`Wgn Witnessed B Sc Y� _ �w, Wh\i LOCATION &CR]NCIZAL INI+OI MA7`ION Location Address L�Z 1�,wecS Owners Name He 4enq pb,j e r t 1�f1Je, C-M-Crv%ile , Address po AAKs CeAery Ue Assessor's Map/Parcel: I(o7-038 Engineer's Name 5011'ly q'n �A�i�Eeft�J NEW CONSTRUCTION 1/ REPAIR Telephone# 508'1iZ$-331Yy Land Use RESt(JEntTleL Slopes(%) ZO%p t Surface Stones NONE Distances from: Open Water Body Sao$ R Possible Wet-Area 3C t tl Drinking Water Well 500 t- Il Drainage Way_ $Op + (l Property Line 10-t (t Other it SKETCH:(Street mmic,dimensions of lot,exact iocmionS of lest llulcs&perc tests,locale wetlands in proximity to holes) I = mo RECE17VE-D qnm t✓ipl - _ - OCT 7� '. TOWN OF BARNSTABLE \�#3 `` \� HEALTH DEPT. Parent material(geologic) QAt nSh 1�lglr\ Depth to Bedrock 300 + Depth to Groundwater: Standing Water in hole: NONE- Weeping from Pit face NJI� Estimated Seasonal llighGroundwater eL• FKplvt TO.V �RpuND wRTe�p1AY� �C`I'CIt1VYYNA "YUN x+Ult SIEASON'AL:YYIGII;'VVA`I EI0'AI3i,1� Method Used. lloNE-SEA AzrnnE _ Depth Observed standing in obs.hole: in. Depth to soil mollies: Depth to weeping from side of obs.hole: in• • index Well N_-_ RraJinR Dalc:� _ InJcx Wcll Icvcl in. Groundwater Adjuslntcnl n. Adj.factor At j.Gruundwater Level ITftco .A'I'ION MUST ` DA10 l ttq a I :I 04: Observation Hole N Z Time at 9" Depth of Pere 35 'time at 6" Start Pre-sunk Tinge Q ZS &ALLDAl Time(9"-G') End Pre-soak mt4 IZ M ln. r5 Rate Min./Inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Tesling Needed(Y/N) Original: Publie Ileallll Division Obsc1'vation hole Data To 13C Completed on 13aclt j Copy: Applicant ULLI' U1 CIMA`1"tON ilO1.L L — De m moll ILL: p Soil Horizon Soil'fcxturc Soil Color Soil Other Surface(in.) (USDA) Munscll ( ) Mollling (Structure,Shines,noulderes. MED. SAWb w/ S ". onsislcncv o 'ra_vcl) 0-►4'1 R sang F1NGS IoYP.y/z _ --- m©- SAA1D _ iOYK4/(g_ 33-IZ(3 L Ea. Ant Z•S — Depth from Soil Ilorizon Soil'1'cxlurc Soil Color Surface(in.) Soil Other (USDA) (Munscll) Motlliu g (Slruclurc,Stories,noulderes. 9Y1GD• 5">L4 Consistcucv.% ravcl) 1z" A StMe F Mt 0 y Z i IZ- Zg i3 ml=z>.s D to R 4j ---- Z -47 C meD. SANIJ -Z.SY (o _ �rnrn llLCI' ( 13 it`Vn` ON, l�olc# Dcplh from Soil Ilorizon Soil'I'cxlnc Surface(ill.) Soil Color Soil Other (USDA) (Munscll) MOI(Iill g (Slruclurc,Sloncs,buuldcres. �r.. mED• Npu/ o I 15 iS(CLGY.Lu ravel)_ O-IZ A s E lrv� IZ-ZOtt - mlva. t� toe 4 llEC�' 013SLItVA11TON I)E Loc Z[u�e Depth from Soil Ilorizon Soil Texture Soil Color Surface(in.) Soil Olhcr (USDA) (Munscll) Moulin g (SUuclurc Sloncs uUh .n . Consi�cncy_,�C;rrv_cl) .flood lnsurauce Rate Mal); Above 500 year flood boundary No Ycs Within 500 year boundary No v- Ycs Within 100 year flood boundary No / Yes nth of Naturally Occurring ravions M.ttel i rl Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? —YE5 If not,what is the depth of naturally occurring pervious material? 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UPON COYKLM OF POST & BEAM t41� ses�aos � � R IS 70 E RE111RO PRWRY 10 N WAT POSE AND VAL 46'-9 1/2" 6'-6" 10'-5 5/8" 7'-0 3/4" IV-5 5/8' 12'-3 1/2" 3 1/2" 10'-2 1/8' T1/22'-0" -- ---- I I I 1 I I o 0 1 I I I I 1 1 I I I I I I I I I I I I I I----- -- -----t------ I I ht 1 - --- ----------- 1 I LOW STORAGE > I o I I 1 1 I o I I �i ♦ 1 oCD I I I x o III 1 N 1 I I 1 1 I m LIt I a ---- 2886 j � j� `♦ I � I 11 1 CA I I ♦ I I 1 , fmo cch / >4 Ib_ 7'-013/4 10'-5 h----------------- �- 0-5 5/8 1 L 1 1 I 1 1 c e I I _ Ig I I N ♦ I g ."O 0 ; I L———————————————— J N I � mv `♦ I N u0 1 o O I ♦ of z 1 w I o o I I o I I a I --- --- 35 L -4------ -- --- -----�-- -- 1 I I I I 1 1 I 1 I I I o I o m r i 1 o I oa rn I 1 C I 1 rn I I -rl i I I � I I O O 1 I � I L--- --- --- ---- r- 2'-9" 2'-11' Z10'-2 1/B• 10'-2 1/B" 3 1/2' 3 1/ 6'-6" 10'-5 5/6' 7'-0 3/4" 10'-5 5/8" 12'-3 1/2' ND >� WISED OB/05/04 HSOF t004 MACIOLEK RESIDENCE ^ o � WF y1� CUSTOM HOMESTEAD 14 REWI�0��1��H r R IHIS DRAWW IS THE PROPERLY or HABITAT POET AND BEAM. IT IS NOT TO HSW REPRODIR3D, DIStXD®TO OI IM OR OTNER<rISE USED N ANY MANIER EXCEPT 4pEpUi�aD, - UM COMKM OF 0i373 >dE1/4'1. AS Arty WRM BE FEiU1 W By T PROIIPILYPW AND TOHABITAT POST AND BEAM. t41 POST & BEAM � 0°B �� I _- . F e OW 1Sod IVMM QL AldIl W a3WAM 38 Q1 SI L! 'M 03ZItlo WN Boor-ass(tit) Wd38 �8 1SOd � JO NOlL31M N(kM WfA QNV 190d 1VMM A9 MU6M M MMW SV wto VH VULMN S IBM IM M AIM NI 03M BMW W W VMW QL M35fl19510 ' imm ffe 11 A 01 m SI A 71A ow nu 1VIM!Q AUU Md mu.sl auva0 qu AmHa iw lBSH t% ��1 to, o0 in . 3ON30IS38 N3-IOIOVVq IN m .Z/18-,8 .9-,£ .0-,9 «0-,9t. .0-,9 .9-,9 z Q 2 LL J W W o ,o J x W b J n n 89 OD a 0E n W N CO LLI�f II < n CA!) n 0'nl N O O to bo to ,p o 699Z • pow o � 6 m o U) b�e x b m Z °i � m h o OD i M O O To OD Mwo a 9£IMX9 ix c O b io 0, o a LL.. x Ub M LLI l 31-90S-S nHL-VM BHL 1 9£IMX0 - «Z/l 8-,9b .0-191 O Tr-ST H0L.% -1 GRADW. 6 S L• \q. O TEST HOL6� - 'Z G-RADE ELr 3Z.1� Cranberi�- DK.GRI H N F. AN SIA.BRIy M¢.0. 5AH0 D94 GR'18 Q,ROW KA0 SD A I.. - =U `•,::• '\� = a �� SOw1EFLNES IOYR w/2 SoMst=1NE5 10yR 'a/ZL DK. YGI_\SN pRN MEP t2 pARtt vE�ISN C3RN MusD ( D LT, YEL'1SN 8RN I��FP. YE\.:\SN f3Rrl MEO SAWD 1OYR `4.t&SANO I0YR4lto _O - ' RW D3A 28 \l /. C SANG 2 SY /Lf , C SAND, 2.5`1 6/Y .L^ " - � ••� I ', +j/ CUS 12o r agbe NO GROUND'VVATEtZ PEI�C 0 'SS' add �� . //l- I •'+ _. •� t-ESb TW AN 2'MIN/tNCM py: SLtLLIVAN rzNGIN 6ER1NCr lNC `_ �.- ,� J F TEST HOLt? -3 GRADE E\.• 37. 1 wITNES�'. SAMwHITE,T p,F3, p,0.1�, '.\ r l�/„_, \ ' 0 pATs t O/t t./0'S _ PK. C fR'IS M SAND H ORN EO SAD PP-RC. O. 101599 � �'� SOMM T=%tJ S \O YR U/Z �� , I Bd1/ A — l2 �\ . -,3,, a Ba pK .YLL'1SN DRN MEP• ran m k 8 3Ari 0 .1 0 Y R 4/!,0 2.0 C 1.-T VC\ \6Fi DRN MC17, •I 'ue i0,.o No G2oUr,+DwATLft .` o .�. s LOCUS PLAN Scale: 1"= 2000' Assessors Map 167 Parcel 38 Zoning RD-I Setbacks: Front-- 30' Side : 10' Rear * 10' Groundwater Overlay:AP F•G.40.0 FG.34.0 ri 11 R ,il p 31.3 30.0 I m 1500 Gallon Top El.31.0 J 30.8 Septic Tank 30.6 Bor.El.28.0 30.418.5 Bedding as Bottom T.H.-I El.9.5 Per Title 5 r DELVELOPED PROFILE OF PROPOSED SF-PTIC SYSTEM It Not to Scale / it / I / I I / 1 I NOTES Grade / I. Water Supply For This Lot is Municipal Water. 2 a 2.Location of Utilities Shown on This Plan Are Approx. ? Filter / 1/ At Least 72 Hours Pricr to Any Excavation For This ^ Fabric Compacted Fin ( / Project The Contractor Shall Make The Required Notification to DIG SAFE-1-888-344-7233. d 1 a"-1/2 / 3.The Contractor is Required to Secure Appropriate I / / I I Permits From Town.Agencies For Construction "' Defined by This Plan. t Leaching / I Chamber 3/4"-I I/2"Doubt. 4.Install Risers as Required to Within 12"of Finished N R Washed Grade. I 5.All Structures Buried Four Feet (4) or More or - t. 12-o° I 6 / I Subject to Vehicular to be H-20 Loading. / ( ? 6.Septic System to be Installed in Accordance With CROSS SECTION OF CHAMBER 310 CMR 15.00 Latest Revision And The Town of NOT To SCALE Barnstable Board of Health Regulations. 7. All Piping Lobe Sch.40 PVC. / I / I O \V/ I I i o DESIGN DATA Single Family-5 Bedroom /' I No Garbage Grinder Daily Flow: 110 x 5 = 550 gpd Septic Tank: 550 gpd x 200 =1100 and -_ _ - r/ ✓ 1 ' I �0 Use a 1500 Gallon Septic Tank. -- LEACHING AREA 550 gpd/0.74=745 s.f.'Required Sidewall:2(12+45 )2= 226s.f. Bottom Area. 12'x 45 = 540 s.f. / 768 s.f.Total Provided. LEACHING CHAMBER DESIGN i I Al I Pipes to be Schedule 40 PVC. Use 5 -500 Gallon Leaching Chambers in oo 12'x45' Washed Stone Field as Shown. / I z 1 i a j e, A 1 ` .y I yA o i \ I ao t c ( ' o N A 1 � I 40l / 1 I I t.les I ' I --I-- - �- terV, ? kil 21 � N ry ro +h M J SITE PLAN PROPOSED SITE IMPROVEMENTS PLAN VIEW AT Scale: 1"= 30' 42 POWERS DRIVE CENTERVILLE . MASS. FOR JOHN & ELIZABETH MACIOLEK SCALE:AS SHOWN DATE: DEC. 9 , 2003 SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. ZO0 2 G C IL1..• R. rEgT HOLE -'2- GRADE ELI b S2.• 1�Cranberrf �j O T55T HOLD -1 RAO O (1� J DK.GRiSV4.SRN MrrD• SANO A 0t< , GR'ISW QROWN MF_0- SAND A SOME FINS 10YR 1.4/2 „ SOME FINES \OyR 1 yo _ ltiortJ�- • •• \\ t- DK. YELISH QRt4 MEO I� DARK vEL'1SW 13RN Mfs0 find D B 6ANp \O VR y/(o o Y Y � SANO IOYR 4/l0 �, �• D3 1 2t3° C 1-7. Y6LISF1 gRN 1�1eD• . wt ' SAND 2 •SY to/ , C SANG 21sY 6/`I COs Y �•:�� 1��'`_ '', `I�.•f;r ' '-17 o �j�y 12 NO GROUND VI/Are_R PeRc- a 3SIr aNAe /�° - 1~•. •/ L�SF'r1-4AN '1't-AkN/INCH �aaa� 0 py: Sll 1-L1VAN cNGIN 6GrtING 1NC• ��`J TabT NaLO 0EEL• 37. 1 WITN�55' SAMWNITL=,TO.F3, p,0•\�, :\ e .'~ 1\��II O PA'-rm.. to/IV/o3 �'' > , Cudd�r ,a PK• 'ISH BRN EI7 SALVO PERC. No. 10,-5 99 SOM 6R M A F1►J�S \OYR 4/2 \o. �� j'Z l— BQ?/:• 1 00 gE B pK• vLL'18H DRN MEP• �p�l. n Bom�� R��. ^� SAND 10 `/R '-l/!a •in �� )" ,- •' 20 scahl uI ��� I o .-T 1 YG.L'\SH 0RN MCO. and I •' �,. \• - C SAND 2.5`/ G/y .1 " NO GROUroDWA_rr__ /Q Ii •.�G Q LOCUS PLAN Scale: l"= 2000' Assessors Map 167 Parcel 38 Zoning RD-I Setbacks: Front: 30 Side 10 Rear 101 j Groundwater Overlay:AP F.G.40.0 F.G•34.0ri r] n 'il p 31.3 30.0 I m w 1500 Gal Ion ,I Top El.31.0 30.8 Septic Tank Bot.El.28.0>, 30.4 30.2 1 ..r •. :r ..:.ems 18.5 n. v' r Bedding as Bottom T.H.-I EI. 9.5 Per Title 5 i DELVELOPED PROFILE OF PROPOSED SF-PTIC SYSTEM / Not to Scale / / II / � I Flelsn NOTES Grade 1 I. Water Supply For This Lot is Municipal Water. 2.Location of Utilities Shown on This Plan Are Approx. .a Filter L_.Compacted FIII At Least 72 Hours Pricr toAny Excavation For This Project The ,ontractLr Shall Make The Reqquired N I Notification to DIG SAFE-1-888-344-7233. Pea Stme 3.The Contractor is Required to Secure Appropriate I I Permits From Town.Agencies For Construction Defined by This Plan. N cn m er 3/d'-I vz"oaabl. 4.Install Risers as Required to Within 12"of Finished R waened o h� Grade. �_ a-Io' I o' i 5.AlI Structures Buried Four Feet (4) or More or I_ Iz'-o" I / 1 b Subject to Vehicular to be H-20 Loading. i/ I 7 6.Septic System to be Installed in Accordance With CROSS SECTION OF CHAMBER 310 CMR 15.00 Latest Revision And The Town of NOT To SCALE Barnstable Board of Health Regulations. o 7All Piping Lobe Sch.40 PVC. \ / I O o \ , I DESIGN DATA \\ I I to Single Family-5 Bedroom No Garbage Grinder / I Daily Flow* 110 x 5 = 550 gpd Septic Tank: 550 gpd x 200%=1100 gpd Use a 1500 Gallon Septic Tank. LEACHING AREA 550 gpd/0.74=7J5 s.f.Required Sidewalk 2(12+45 )2= 228 ,.f. Bottom Area: I'L'x 45°='540 S.f. 768 sf.Total Provided. LEACHING CHAMBER DESIGN / ✓ Al I Pipes to be Schedule 40 PVC. Use 5 -500 Gallon Leaching Chambers in a N 12 x45 Washed Stone Field as Shown. \X// o a I I s 3•e 1 / / / �k o s /I2' / AN . 'O tic /` I � I /r / / / v / rd •?L, A oe 1 I a�� ° LOT ARE-h S^sro I _TES n 00 I it G,)7 23 �•9� / !t 1 / �� ai9tge e Reel , 7 ,i r rv ^� ro o to J Cb O -V S SITE PLAN PROPOSED SITE IMPROVEMENTS PLAN VIEW AT Scale* I "= 30' 42 POWERS DRIVE CENTERVILLE ,MASS. FOR JOHN & ELIZABETH MACIOLEK SCALE- AS SHOWN DATE: DEC. 9 , 2003 SULLIVAN ENGINEERING INC. OSTERVILLE , MASS. Z`�0 2